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Chen J, Wang G, Ding Y, Zhang Z, Xia K, Xu L, Xu X. Development of an AI-Assisted System for Automatic Recognition and Localization Marking of Colonic Polyps (With Video). J Gastroenterol Hepatol 2025. [PMID: 40229187 DOI: 10.1111/jgh.16980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2025] [Revised: 03/08/2025] [Accepted: 04/07/2025] [Indexed: 04/16/2025]
Abstract
BACKGROUND Localizing colorectal polyps identified during the initial colonoscopy in minimally invasive endoscopic surgery presents significant challenges. These challenges include imprecise location descriptions, unclear images, a high number of polyps, and polyp characteristics such as flat shapes and low color contrast. To address these issues, we developed an AI-assisted system for the automatic detection and localization of colorectal polyps. METHODS Colonic images and videos from three medical centers, collected between January 2018 and August 2024, were categorized based on pathology results into normal, adenomatous polyp, and serrated lesion groups. Transfer learning and fine-tuning were conducted on five pretrained CNN models, with performance evaluated using metrics such as accuracy, precision, sensitivity, and AUC. The best-performing model was selected for interpretability analysis and developed into an AI-assisted system capable of both polyp recognition and location marking. RESULTS Among the five models, EfficientNetV2 performed the best, achieving accuracy, precision, sensitivity, and F1 scores of 0.933, 0.917, 0.916, and 0.917, respectively, on the validation set. On the test set, the model's overall weighted average precision, specificity, and AUC were 0.903, 0.946, and 0.983, respectively. Two representative colonoscopy case videos predicted by the model further demonstrated the feasibility of this AI system in clinical practice. CONCLUSIONS The AI system we developed for the automatic recognition and localization marking of colonic polyps in colonoscopy aids in the rapid localization of polyps during minimally invasive endoscopic surgery.
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Affiliation(s)
- Jian Chen
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
- Changshu Key Laboratory of Medical Artificial Intelligence and Big Data, Suzhou, China
| | - Ganhong Wang
- Department of Gastroenterology, Changshu Traditional Chinese Medicine Hospital (Changshu Hospital Affiliated to Nanjing University of Chinese Medicine), Suzhou, China
| | - Yu Ding
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Zihao Zhang
- Shanghai Haoxiong Education Technology Co, Ltd, Shanghai, China
| | - Kaijian Xia
- Changshu Key Laboratory of Medical Artificial Intelligence and Big Data, Suzhou, China
- Center of Intelligent Medical Technology Research, Changshu Hospital Affiliated to Soochow University, Suzhou, China
| | - Lu Xu
- Department of Gastroenterology, Changshu Traditional Chinese Medicine Hospital (Changshu Hospital Affiliated to Nanjing University of Chinese Medicine), Suzhou, China
| | - Xiaodan Xu
- Department of Gastroenterology, Changshu Hospital Affiliated to Soochow University, Suzhou, China
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Shi YH, Liu JL, Cheng CC, Li WL, Sun H, Zhou XL, Wei H, Fei SJ. Construction and validation of machine learning-based predictive model for colorectal polyp recurrence one year after endoscopic mucosal resection. World J Gastroenterol 2025; 31:102387. [PMID: 40124266 PMCID: PMC11924002 DOI: 10.3748/wjg.v31.i11.102387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 01/25/2025] [Accepted: 02/14/2025] [Indexed: 03/13/2025] Open
Abstract
BACKGROUND Colorectal polyps are precancerous diseases of colorectal cancer. Early detection and resection of colorectal polyps can effectively reduce the mortality of colorectal cancer. Endoscopic mucosal resection (EMR) is a common polypectomy procedure in clinical practice, but it has a high postoperative recurrence rate. Currently, there is no predictive model for the recurrence of colorectal polyps after EMR. AIM To construct and validate a machine learning (ML) model for predicting the risk of colorectal polyp recurrence one year after EMR. METHODS This study retrospectively collected data from 1694 patients at three medical centers in Xuzhou. Additionally, a total of 166 patients were collected to form a prospective validation set. Feature variable screening was conducted using univariate and multivariate logistic regression analyses, and five ML algorithms were used to construct the predictive models. The optimal models were evaluated based on different performance metrics. Decision curve analysis (DCA) and SHapley Additive exPlanation (SHAP) analysis were performed to assess clinical applicability and predictor importance. RESULTS Multivariate logistic regression analysis identified 8 independent risk factors for colorectal polyp recurrence one year after EMR (P < 0.05). Among the models, eXtreme Gradient Boosting (XGBoost) demonstrated the highest area under the curve (AUC) in the training set, internal validation set, and prospective validation set, with AUCs of 0.909 (95%CI: 0.89-0.92), 0.921 (95%CI: 0.90-0.94), and 0.963 (95%CI: 0.94-0.99), respectively. DCA indicated favorable clinical utility for the XGBoost model. SHAP analysis identified smoking history, family history, and age as the top three most important predictors in the model. CONCLUSION The XGBoost model has the best predictive performance and can assist clinicians in providing individualized colonoscopy follow-up recommendations.
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Affiliation(s)
- Yi-Heng Shi
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
- The First Clinical Medical College of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
| | - Jun-Liang Liu
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
| | - Cong-Cong Cheng
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
- The First Clinical Medical College of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
| | - Wen-Ling Li
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
- The First Clinical Medical College of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
| | - Han Sun
- Department of Gastroenterology, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou 221009, Jiangsu Province, China
| | - Xi-Liang Zhou
- Department of Gastroenterology, Xuzhou Central Hospital, The Affiliated Xuzhou Hospital of Medical College of Southeast University, Xuzhou 221009, Jiangsu Province, China
| | - Hong Wei
- Department of Gastroenterology, Xuzhou New Health Hospital, North Hospital of Xuzhou Cancer Hospital, Xuzhou 221007, Jiangsu Province, China
| | - Su-Juan Fei
- Department of Gastroenterology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu Province, China
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Yang Y, Li Y, Huang C, Yu T, Li J. Evaluation of the Cold vs Hot Snare Endoscopic Resection of Large Nonpedunculated Colorectal Polyps in the German CHRONICLE Trial. Gastroenterology 2025; 168:428-429. [PMID: 39461445 DOI: 10.1053/j.gastro.2024.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 09/18/2024] [Indexed: 10/29/2024]
Affiliation(s)
- Yu Yang
- College of Integrative Chinese and Western Medicine, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China; Department of Anorectal, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Yaling Li
- Department of Pharmacy, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
| | - Chengzi Huang
- Department of Anorectal, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China; Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ting Yu
- Sichuan Tianfu New Area People's Hospital, Chengdu, Sichuan, China
| | - Jun Li
- College of Integrative Chinese and Western Medicine and Department of Anorectal, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
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Hirose R, Yoshida N, Yoshida T, Mukai H, Yamauchi K, Miyazaki H, Watanabe N, Bandou R, Inoue K, Dohi O, Inagaki Y, Inada Y, Murakami T, Yanagisawa A, Ikegaya H, Nakaya T, Itoh Y. High‐Performance Dedicated Snares with Tip Attachments can Overcome Current Disadvantages in Cold Snare Polypectomy. ADVANCED MATERIALS TECHNOLOGIES 2025; 10. [DOI: 10.1002/admt.202401055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Indexed: 01/12/2025]
Abstract
AbstractCold snare polypectomy (CSP) has the disadvantage of a lower histopathological complete resection rate (HCRR) because blunt resection using CSP‐dedicated snares (DSs) causes mucosal retraction into the sheath during capture/resection. In this study, attachments are designed to narrow the sheath tip's inner diameter from 1.8 to 1.3‒1.1 mm to prevent mucosal retraction. Eight prototype snares with different component characteristics are combined with these attachments. Additionally, product version DS with attachment (Smart Snare Cold) and existing DSs, such as Exacto Cold Snare, are prepared. For snare performance evaluation, the force required to resect (FRR) human colonic mucosa, mucosal retraction amount (MRA), and clinical data are obtained. The attachments that narrowed the inner diameter to 1.3 or 1.1 mm reduce the FRR to 74.9%−93.8% and 68.0%−84.9%, respectively, and reduce the MRA to 21.0%−35.3% and 15.1%−26.8%, respectively. Thus, the reduced inner diameter improves resection ability and prevents mucosal retraction. The clinical findings show that Smart Snare Cold has significantly higher muscularis mucosa resection rates and HCRRs than Exacto Cold Snare (P < 0.001 and P = 0.003, respectively). Thus, the novel DS with tip attachment improves the HCRR and overcomes the current CSP disadvantage by simultaneously improving resection ability and preventing mucosal retraction.
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Affiliation(s)
- Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
- Department of Infectious Diseases Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Takuma Yoshida
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Hiroki Mukai
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
- Department of Infectious Diseases Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Katsuma Yamauchi
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
- Department of Infectious Diseases Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Hajime Miyazaki
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
- Department of Infectious Diseases Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Naoto Watanabe
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
- Department of Infectious Diseases Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Risa Bandou
- Department of Forensic Medicine Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto 602‐8566 Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Yoshikazu Inagaki
- Department of Gastroenterology Nishijin Hospital Kyoto 602‐8319 Japan
| | - Yutaka Inada
- Department of Gastroenterology Kyoto First Red Cross Hospital Kyoto 605‐0981 Japan
| | - Takaaki Murakami
- Department of Gastroenterology Aiseikai Yamashina Hospital Kyoto 607‐8086 Japan
| | - Akio Yanagisawa
- Department of Pathology Kyoto First Red Cross Hospital Kyoto 605‐0981 Japan
| | - Hiroshi Ikegaya
- Department of Forensic Medicine Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto 602‐8566 Japan
| | - Takaaki Nakaya
- Department of Infectious Diseases Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology Graduate School of Medical Science Kyoto Prefectural University of Medicine 465 Kajii‐cho, Kawaramachi‐Hirokoji, Kamigyo‐ku Kyoto 602‐8566 Japan
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Oh CK, Cho YW, Jung J, Lee HY, Kim JB, Cho YS. Comparison of cold snare endoscopic mucosal resection and hot snare endoscopic mucosal resection for small colorectal polyps: a randomized controlled trial. Sci Rep 2024; 14:20335. [PMID: 39223224 PMCID: PMC11369165 DOI: 10.1038/s41598-024-71067-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024] Open
Abstract
Incomplete resection rates vary among endoscopists performing cold snare polypectomy. Cold snare endoscopic mucosal resection (CS-EMR) is the technique of cold resection after submucosal injection to reduce incomplete resection. This study aimed to evaluate the efficacy and safety of CS-EMR for small colorectal polyps compared to hot snare endoscopic mucosal resection (HS-EMR). Preplanned sample size required 70 polyps to CS-EMR group or HS-EMR group, respectively. Patients with polyps sized 6-9 mm were randomly allocated to either the CS-EMR or the HS-EMR group. The primary outcome was residual or recurrent adenoma (RAA) rate. A total of 70 and 68 polyps were resected using CS-EMR and HS-EMR, respectively. In the intention-to-treat population, the RAA rate was 0% in the CS-EMR group and 1.5% in the HS-EMR group (risk difference [RD], - 1.47; 95% confidence interval [CI] - 4.34 to 1.39). En bloc resection rate was 98.6% and 98.5% (RD, - 0.04; 95% CI - 4.12 to 4.02); the R0 resection rate was 55.7% and 82.4% (RD, - 27.80; 95% CI - 42.50 to - 13.10). The total procedure time was 172 s (IQR, 158-189) in the CS-EMR group and 186 s (IQR, 147-216) in the HS-EMR group (median difference, - 14; 95% CI - 32 to 2). Delayed bleeding was 2.9% vs 1.5% (RD, 1.37; 95% CI - 3.47 to 6.21) in both groups, respectively. CS-EMR was non-inferior to HS-EMR for the treatment of small colorectal polyps. CS-EMR can be considered one of the standard methods for the removal of colorectal polyps sized 6-9 mm.
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Affiliation(s)
- Chang Kyo Oh
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University of Korea, 1 Singil-ro, Yeoungdeungpo-gu, Seoul, 07441, South Korea.
| | - Young Wook Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jiyoon Jung
- Departments of Pathology, Hallym University Kangnam Sacred Heart Hospital, Hallym University of Korea, Seoul, South Korea
| | - Hee Yeon Lee
- Departments of Biostatistics, Soonchunhyang University Hospital Seoul, Soonchunhyang University of Korea, Seoul, South Korea
| | - Jin Bae Kim
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University of Korea, 1 Singil-ro, Yeoungdeungpo-gu, Seoul, 07441, South Korea
| | - Young-Seok Cho
- Division of Gastroenterology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Chaptini LA, Jalloul S, Karam K. Cold snare polypectomy: A closer look at the efficacy and limitations for polyps 10-20 mm in size. World J Gastrointest Endosc 2024; 16:445-450. [PMID: 39155992 PMCID: PMC11325874 DOI: 10.4253/wjge.v16.i8.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 06/29/2024] [Accepted: 07/29/2024] [Indexed: 08/01/2024] Open
Abstract
Current guidelines recommend cold snare polypectomy for polyps less than 10 mm in size. Conversely, endoscopic mucosal resection is still the preferred technique for larger polyps. Concerns regarding cold snare polypectomy for larger polyps revolve around the difficulty in conducting en-bloc resection (resulting in piecemeal removal), and the potential for local residual polyp tissue and a high rate of recurrence. On the other hand, cold snare technique has the advantages of shortening procedure time, reducing delayed bleeding risks and lowering cost of treatment. Numerous ongoing and recent studies are focused on evaluating the risks and benefits of this technique for polyps larger than 10 mm, with the goal of providing clear guidelines in the near future. The aim of this editorial is to provide our readers with an overview regarding this subject and the latest developments surrounding it.
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Affiliation(s)
- Louis A Chaptini
- Department of Medicine, Digestive Diseases, Yale School of Medicine, New Haven, CT 06510, United States
- Department of Medicine, Gastroenterology, University of Balamand, Balamand 100, Lebanon
| | - Sarah Jalloul
- Department of Medicine, Gastroenterology, University of Balamand, Balamand 100, Lebanon
| | - Karam Karam
- Department of Medicine, Gastroenterology, University of Balamand, Balamand 100, Lebanon
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Hamada K, Honda M, Horikawa Y, Shiwa Y, Techigawara K, Nagahashi T, Ishikawa M, Takeda Y, Fukushima D, Nishino N, Uesugi N, Suzuki M, Sugai T. Histopathologic vertical margin positivity in cold snare polypectomy and mucosal resection for sessile serrated lesions. Gastrointest Endosc 2024; 100:283-291. [PMID: 38272275 DOI: 10.1016/j.gie.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/28/2023] [Accepted: 01/16/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND AND AIMS Data regarding the status of the vertical margin of sessile serrated lesions (SSLs) resected using cold snare polypectomy (CSP) are lacking, and whether a histopathologically positive vertical margin is related to recurrence remains unclear. Therefore, this preliminary study aimed to clarify the rates of positive or unassessable vertical and horizontal margins and the rate of muscularis mucosae resection in SSLs treated using CSP compared with those treated with EMR. METHODS Histologic outcomes of patients treated with CSP or EMR for SSLs were evaluated in this single-center observational study. The primary outcome was the incidence of histopathologically positive vertical margins in CSP and EMR. Furthermore, the comparisons were adjusted for confounding factors using propensity score matching. RESULTS Overall, 82 patients with SSLs were included in the CSP and EMR groups after matching. The incidence of positive histologic vertical margins in the CSP and EMR groups were 67.1% and 2.4%, respectively (P < .001). Regarding the evaluation of the presence of muscularis mucosae, 29.3% and 98.8% of patients in the CSP and EMR groups, respectively, had a complete muscularis mucosae resection (P < .001). CONCLUSIONS A rigorous histopathologic evaluation revealed that for SSLs, CSP more frequently leads to positive vertical margins than EMR. (Clinical trial registration number: UMIN 000051569.).
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Affiliation(s)
- Koichi Hamada
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan; Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan; Department of Surgery, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Yoshinori Horikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Yoshiki Shiwa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Kae Techigawara
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan; Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Takayuki Nagahashi
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan; Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Masafumi Ishikawa
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Yuki Takeda
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Daizo Fukushima
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Noriyuki Uesugi
- Department of Pathology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Masamichi Suzuki
- Department of Pathology, Southern-Tohoku General Hospital, Koriyama, Japan
| | - Tamotsu Sugai
- Department of Pathology, Southern-Tohoku General Hospital, Koriyama, Japan
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Nomura K, Shibuya T, Yuzawa A, Omori M, Odakura R, Koma M, Ito K, Kamba E, Maruyama T, Nomura O, Fukushima H, Murakami T, Ueda K, Ishikawa D, Hojo M, Nagahara A. Residual Recurrence of a Small Intestinal Capillary Hemangioma with Obscure Gastrointestinal Bleeding Treated by Double-Balloon Endoscopy: A Case Report and Literature Review. J Clin Med 2024; 13:3415. [PMID: 38929942 PMCID: PMC11204303 DOI: 10.3390/jcm13123415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/03/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
An 86-year-old man presented with anemia. He underwent abdominal contrast-enhanced computed tomography, gastroscopy, and colonoscopy without any bleeding detected. Small bowel capsule endoscopy (SBCE) revealed a reddish polypoid lesion with blood oozing into the jejunum. Antegrade double-balloon endoscopy (DBE) revealed a 5 mm sized protrusion into the jejunum. Endoscopic mucosal resection (EMR) was difficult; the lesion was snared and resected before energization. Clips prevented further bleeding and the lesion's position was marked with a tattoo. Histopathological examination of the lesion led to a diagnosis of capillary hemangioma. After 11 months, the patient was again anemic. A reddish polypoid lesion oozing blood near the tattoo was found by SBCE. Another antegrade DBE showed a 7 mm sized protrusion near the tattoo. The lesion was successfully treated by EMR. Histopathological examination revealed the residual recurrence of a small intestinal capillary hemangioma. The patient recovered from anemia after the EMR. Two months later, SBCE showed no findings around the tattoo. Hemangiomas account for 7-10% of benign small intestinal tumors; most are cavernous hemangiomas, and capillary hemangiomas are rare. We report a rare case of a recurring small intestinal capillary hemangioma detected by SBCE and treated using DBE. We also review the literature.
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Affiliation(s)
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, School of Medicine, Juntendo University, Bunkyo-ku, Tokyo 113-8421, Japan; (K.N.); (A.Y.); (M.O.); (R.O.); (M.K.); (K.I.); (E.K.); (T.M.); (O.N.); (H.F.); (T.M.); (K.U.); (D.I.); (M.H.); (A.N.)
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Hirose R, Yoshida T, Yoshida N, Yamauchi K, Miyazaki H, Watanabe N, Bandou R, Inoue K, Ikegaya H, Nakaya T, Itoh Y. Factors determining the resection ability of snares in cold snare polypectomy: Construction of an ex vivo model for accurately evaluating resection ability. Dig Endosc 2024; 36:573-581. [PMID: 37682639 DOI: 10.1111/den.14676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVES Cold snare polypectomy (CSP)-dedicated snares (DSs) may have a higher resection ability than conventional snares. However, a model that can accurately and objectively evaluate and compare the resection ability of each snare has yet to be determined, and characteristics of snare parts that increase resection ability remain unknown. Therefore, we elucidated DSs' resection ability and all characteristics of the parts required for acquiring high resection ability. METHODS An ex vivo model for evaluating resection ability was generated using human colons obtained from forensic autopsy specimens. The force required to resect a 15 mm wide human colonic mucosa (FRR) was measured using this model; if the FRR is small, the resection ability is high. Next, after measuring the stiffness of each snare part, the correlation between the stiffness and resection ability was analyzed. RESULTS The force required to resect using SnareMaster Plus, Micro-Tech Cold Snare, Captivator Cold, Exacto Cold Snare, or Captivator II was 13.6 ± 1.0, 12.5 ± 1.2, 7.4 ± 1.2, 6.5 ± 1.0, and 28.7 ± 3.7 N, respectively. All DSs had significantly lower FRR than the conventional snare (Captivator II) and had higher resection ability (P < 0.001). A negative correlation was found between FRR and sheath or wire spindle stiffness, with correlation coefficients of 0.72 (P = 0.042) or 0.94 (P < 0.001), respectively. Moreover, 1 × 7 type wire rings had significantly higher friction coefficients than 1 × 3 type wire rings (P < 0.002). CONCLUSION Sheath and wire spindle stiffness should be increased to increase resection ability; 1 × 7 type wire rings may be suitable for CSP-snare parts.
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Affiliation(s)
- Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takuma Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuma Yamauchi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hajime Miyazaki
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naoto Watanabe
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Risa Bandou
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroshi Ikegaya
- Department of Forensic Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takaaki Nakaya
- Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Minakata N, Murano T, Inaba A, Shinmura K, Ikematsu H. Hot snare polypectomy using bipolar snare: an easy and feasible approach for intermediate-sized colorectal lesions. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2024; 9:251-253. [PMID: 38766405 PMCID: PMC11099305 DOI: 10.1016/j.vgie.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Nobuhisa Minakata
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East Kashiwa, Chiba, Japan
| | - Tatsuro Murano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East Kashiwa, Chiba, Japan
| | - Atsushi Inaba
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East Kashiwa, Chiba, Japan
| | - Kensuke Shinmura
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East Kashiwa, Chiba, Japan
| | - Hiroaki Ikematsu
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East Kashiwa, Chiba, Japan
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Santos CEOD, Malaman D, Sanmartin IDA, Leão ABHS, Bombassaro IZ, Pereira-Lima JC. COLD SNARE POLYPECTOMY: A SAFE PROCEDURE FOR REMOVING SMALL NON-PEDUNCULATED COLORECTAL LESIONS. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:470-477. [PMID: 38018552 DOI: 10.1590/s0004-2803.23042023-115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/10/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Polypectomy is an important treatment option for preventing colorectal cancer. Incomplete polyp resection (IPR) is re-cognized as a risk factor for interval cancer. OBJECTIVE The primary objective was to evaluate the complete polyp resection (CPR) rate for cold snare polypectomy (CSP) in small non-pedunculated polyps and, secondarily, specimen retrieval and complication rates. METHODS We prospectively evaluated 479 polyps <10 mm removed by CSP in 276 patients by an inexperienced endoscopist. RESULTS A total of 476 polyps (99.4%) were resected en bloc. A negative margin (classified as CPR) was observed in 435 polyps (90.8%). An unclear or positive margin (classified as IPR) was observed in 43 cases (9.0%) and 1 case (0.2%), respectively, for an overall IPR rate of 9.2% (44/479). The IPR rate was 12.2% in the first half of cases and 5.9% in the second half (P=0.02). Dividing into tertiles, the IPR rate was 15.0% in the first tertile, 6.9% in the second tertile, and 5.7% in the third tertile (P=0.01). Dividing into quartiles, the IPR rate was 15.8% in the first quartile and 5.9% in the fourth quartile (P=0.03). The IPR rate was 6.3% for type 0-IIa lesions and 14.1% for type 0-Is lesions (P=0.01). For serrated and adenomatous lesions, the IPR rate was 9.2%. Specimen retrieval failed in 3.6% of cases. Immediate bleeding (>30 s) occurred in 1 case (0.2%), treated with argon plasma coagulation. No delayed bleeding or perforation occurred. CONCLUSION CSP is a safe technique that provides good results for the resection of small non-pedunculated polyps, with a short learning curve.
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Affiliation(s)
- Carlos Eduardo Oliveira Dos Santos
- Hospital Santa Casa de Caridade, Serviço de Endoscopia, Bagé, RS, Brasil
- Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Endoscopia, Porto Alegre, RS, Brasil
| | - Daniele Malaman
- Hospital Santa Casa de Caridade, Serviço de Endoscopia, Bagé, RS, Brasil
| | | | - Ari Ben-Hur Stefani Leão
- Pontifícia Universidade Católica do Rio Grande do Sul, Departamento de Endoscopia, Porto Alegre, RS, Brasil
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Kim DH, Park SY, You HS, Jung YW, Joo YE, Myung DS, Kim HS, Kim NI, Kim SJ, Ju JK. Modified underwater endoscopic mucosal resection for intermediate-sized sessile colorectal polyps. Front Med (Lausanne) 2023; 10:1200145. [PMID: 37409275 PMCID: PMC10318795 DOI: 10.3389/fmed.2023.1200145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Underwater endoscopic mucosal resection (UEMR) is effective for treating intermediate-sized colorectal polyps. However, it is sometimes difficult to obtain visibility in underwater conditions. METHODS This prospective, observational, single-center study included consecutive patients with intermediate-sized (10-20 mm) sessile colorectal polyps. Modified UEMR method was used to initially snare the lesion without injection or water infusion. Thereafter, water was infused until the lesion was submerged, then it was resected using electrocautery. We also evaluated the rates of complete resection and procedure-related complications. RESULTS Forty-two patients with 47 polyps were enrolled in the study. The median procedure time and fluid infusion were 71 s (42-607) and 50 mL (30-130), respectively. The rates of R0 resection and en bloc resection were 80.9 and 97.9%, respectively, with 100% technical success. R0 resection was observed in 42.9% of polyps sized ≥15 mm and 87.5% sized <15 mm (p < 0.01). Muscle entrapment was found in 71.4% of patients with polyps sized ≥15 mm and 10% <15 mm (p < 0.01). Immediate bleeding occurred in 12.8% of cases and was controlled using a snare tip or hemostatic forceps. Snare-tip ablation and hemostatic forceps ablation were performed in 27.7 and 6.4% of patients, respectively. No delayed bleeding, perforation, or any other complications were reported. CONCLUSION Modified UEMR can be used in cases in which securing visibility or performing the existing UEMR is challenging. Careful treatment is required when removing polyps >15 mm in size.
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Affiliation(s)
- Dong Hyun Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Seon-Young Park
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Hye-Su You
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Yong-Wook Jung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Young-Eun Joo
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Dae-Seong Myung
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Hyun-Soo Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Nah Ihm Kim
- Department of Pathology, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
| | - Seong-Jung Kim
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chosun University Hospital, Gwangju, Republic of Korea
| | - Jae Kyun Ju
- Division of Colorectal Surgery, Department of Surgery, Chonnam National University Hospital and Medical School, Gwangju, Republic of Korea
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Ulrich JD, Rechberger P, Bachmann J, Herner A, V Figura G, Lahmer T, Phillip V, Mayr U, Haller B, Jesinghaus M, Schmid RM, Abdelhafez M, Schlag C. Efficacy and Safety of Cold Snare Polypectomy of Colorectal Polyps 10-15 mm with a Hybrid Snare: A Prospective Observational Pilot Study. Digestion 2023; 104:391-399. [PMID: 37331350 DOI: 10.1159/000530642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/03/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Cold snare polypectomy (CSP) is a safe and effective procedure for small colorectal polyps ≤9 mm. There are only limited data regarding CSP of larger neoplastic lesions. This study evaluated the efficacy and safety of CSP for polyps between 10 and 15 mm in size. METHODS In this prospective single-arm observational pilot study, patients with a least one polyp 10-15 mm were included. These polyps were preferably removed by CSP using a dedicated hybrid snare. The primary outcome was the histological complete resection rate (CRR) determined by pathologically negative margins of the specimen and no neoplastic tissue obtained from biopsies of the resection site margin. Secondary outcomes were en bloc resection rate, failure of CSP, and incidence of adverse events. RESULTS A total of 61 neoplastic polyps were removed from 39 patients. Overall CRR was 80.3% (49/61). CSP was feasible in 78.7% (48/61) of polyps and the CRR in this group was 85.4% (41/48). When CSP failed (13/61; 21.3%), lesions were successfully resected by immediate HSP using the same snare with a CRR of 61.5% (8/13) in this group. One patient presented delayed hemorrhage after HSP of a polyp but successful hemostasis was achieved with two hemoclips. No other adverse events occurred. No recurrence was seen on follow-up colonoscopy in cases with incomplete resected polyps. CONCLUSION CSP seems to be efficient and safe in removing colorectal polyps up to 15 mm. A hybrid snare seems to be particularly advantageous for these polyps as it allows immediate conversion to HSP if CSP might fail in larger polyps. This trial is registered at ClinicalTrials.gov (NCT04464837).
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Affiliation(s)
- Jörg D Ulrich
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany,
| | - Paul Rechberger
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Jeannine Bachmann
- Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Alexander Herner
- Department for Gastroenterology and Hepatology, Universitätsspital Zürich, Zurich, Switzerland
| | - Guido V Figura
- Private Practice for Gastroenterology and Endoscopy, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Veit Phillip
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Ulrich Mayr
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Bernhard Haller
- Institute of AI and Informatics in Medicine, School of Medicine, Technische Universität München, Munich, Germany
| | - Moritz Jesinghaus
- Institute of Pathology, Philipps-Universität Marburg, Marburg, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Mohamed Abdelhafez
- Department of Internal Medicine II, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christoph Schlag
- Department for Gastroenterology and Hepatology, Universitätsspital Zürich, Zurich, Switzerland
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Jiang Q, Yan X, Wang D, Zhang S, Zhang Y, Feng Y, Yang A, Wu D. Endoscopic mucosal resection using cold snare versus hot snare in treatment for 10-19 mm non-pedunculated colorectal polyps: protocol of a non-inferiority randomised controlled study. BMJ Open 2023; 13:e070321. [PMID: 37217262 PMCID: PMC10230935 DOI: 10.1136/bmjopen-2022-070321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Cold polypectomy has the advantages of simple operation, less time-consuming and fewer complications. Guidelines have recommended cold snare polypectomy (CSP) to resect small polyps sized ≤5 mm and sessile polyps sized 6-9 mm. However, evidence is scarce regarding cold resection for non-pedunculated polyps sized ≥10 mm. Cold snare endoscopic mucosal resection (CS-EMR) combining CSP and submucosal injection was designed to improve the complete resection rate and reduce adverse events. We hypothesise that CS-EMR is non-inferior to conventional hot snare endoscopic mucosal resection (HS-EMR) in the resection of 10-19 mm non-pedunculated colorectal polyps. METHODS AND ANALYSIS This study is a prospective, randomised, open-label, non-inferiority, single-centre trial. Outpatients scheduled to undergo a colonoscopy and present eligible polyps will be randomised to receive either CS-EMR or HS-EMR. The primary endpoint is the complete resection. Considering that HS-EMR of 10-19 mm colorectal polyps will yield a complete resection rate of at least 92% and a non-inferiority margin of -10%, a total of 232 polyps will be included (one-sided α, 2.5%; β, 20%). The analyses are intended to evaluate first non-inferiority (lower limit 95% CI greater than -10% for group difference) and then superiority (lower limit 95% CI>0%) if non-inferiority is achieved. Secondary endpoints include en-bloc resection, the occurrence of adverse events, the use of endoscopic clips, resection time and cost. ETHICS AND DISSEMINATION The study has been approved by the institutional review board of the Peking Union Medical College Hospital (No. K2203). All participants in the trial will provide written informed consent. The results of this trial will be published in an open-access way. TRIAL REGISTRATION NUMBER NCT05545787.
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Affiliation(s)
- Qingwei Jiang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaxiao Yan
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Duan Wang
- Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengyu Zhang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yunlu Feng
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Aiming Yang
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Wu
- Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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15
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Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in flexible sigmoidoscopy. Frontline Gastroenterol 2023; 14:181-200. [PMID: 37056324 PMCID: PMC10086722 DOI: 10.1136/flgastro-2022-102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Joint Advisory Group (JAG) certification in endoscopy is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update standards for training and certification in flexible sigmoidoscopy (FS). METHODS A modified Delphi process was conducted between 2019 and 2020 with multisociety representation from experts and trainees. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on FS training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer-reviewed by national stakeholders for incorporation into the JAG FS certification pathway. RESULTS In total, 41 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (17), assessment of competence (7) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (A) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, rectal retroversion >90%, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (B) minimum procedure count ≥175; (C) performing 15+ procedures over the preceding 3 months; (D) attendance of the JAG Basic Skills in Lower gastrointestinal Endoscopy course; (E) satisfying requirements for formative direct observation of procedural skill (DOPS) and direct observation of polypectomy skill (SMSA level 1); (F) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool and (G) successful performance in summative DOPS. CONCLUSION The UK standards for training and certification in FS have been updated to support training, uphold standards in FS and polypectomy, and provide support to the newly independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospital, Truro, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - John Anderson
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Vathsan Ravindran
- Department of Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, UK
| | - Ian L P Beales
- University of East Anglia, Norwich, UK
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Elizabeth Ratcliffe
- Department of Gastroenterology, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
- Division of Diabetes, Endocrinology and Gastroenterology Faculty of Biology, Medicine and Health School of Medical Sciences, The University of Manchester, Manchester, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Catherine Regan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, UK
| | - Eleanor Wood
- Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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16
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Siau K, Pelitari S, Green S, McKaig B, Rajendran A, Feeney M, Thoufeeq M, Anderson J, Ravindran V, Hagan P, Cripps N, Beales ILP, Church K, Church NI, Ratcliffe E, Din S, Pullan RD, Powell S, Regan C, Ngu WS, Wood E, Mills S, Hawkes N, Dunckley P, Iacucci M, Thomas-Gibson S, Wells C, Murugananthan A. JAG consensus statements for training and certification in colonoscopy. Frontline Gastroenterol 2023; 14:201-221. [PMID: 37056319 PMCID: PMC10086724 DOI: 10.1136/flgastro-2022-102260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/04/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION In the UK, endoscopy certification is awarded when trainees attain minimum competency standards for independent practice. A national evidence-based review was undertaken to update and develop standards and recommendations for colonoscopy training and certification. METHODS Under the oversight of the Joint Advisory Group (JAG), a modified Delphi process was conducted between 2019 and 2020 with multisociety expert representation. Following literature review and Grading of Recommendations, Assessment, Development and Evaluations appraisal, recommendation statements on colonoscopy training and certification were formulated and subjected to anonymous voting to obtain consensus. Accepted statements were peer reviewed by JAG and relevant stakeholders for incorporation into the updated colonoscopy certification pathway. RESULTS In total, 45 recommendation statements were generated under the domains of: definition of competence (13), acquisition of competence (20), assessment of competence (8) and postcertification support (4). The consensus process led to revised criteria for colonoscopy certification, comprising: (1) achieving key performance indicators defined within British Society of Gastroenterology standards (ie, unassisted caecal intubation rate >90%, rectal retroversion >90%, polyp detection rate >15%+, polyp retrieval rate >90%, patient comfort <10% with moderate-severe discomfort); (2) minimum procedure count 280+; (3) performing 15+ procedures over the preceding 3 months; (4) attendance of the JAG Basic Skills in Colonoscopy course; (5) terminal ileal intubation rates of 60%+ in inflammatory bowel disease; (6) satisfying requirements for formative direct observation of procedure skills (DOPS) and direct observation of polypectomy skills (Size, Morphology, Site, Access (SMSA) level 2); (7) evidence of reflective practice as documented on the JAG Endoscopy Training System reflection tool; (8) successful performance in summative DOPS. CONCLUSION The UK standards for training and certification in colonoscopy have been updated, culminating in a single-stage certification process with emphasis on polypectomy competency (SMSA Level 2+). These standards are intended to support training, improve standards of colonoscopy and polypectomy, and provide support to the newly independent practitioner.
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Affiliation(s)
- Keith Siau
- Department of Gastroenterology, Royal Cornwall Hospitals NHS Trust, Truro, Cornwall, UK
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
| | - Stavroula Pelitari
- Department of Gastroenterology, Royal Free London NHS Foundation Trust, London, London, UK
| | - Susi Green
- Department of Gastroenterology, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Brian McKaig
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, Greater London, UK
| | - Mark Feeney
- Department of Gastroenterology, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Mo Thoufeeq
- Department of Gastroenterology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
| | - John Anderson
- Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
| | - Vathsan Ravindran
- Gastroenterology, St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Paul Hagan
- Endoscopy, Royal Derby Hospital, Derby, UK
| | - Neil Cripps
- Colorectal Surgery, University Hospitals Sussex NHS Foundation Trust, Worthing, West Sussex, UK
| | - Ian L P Beales
- Department of Gastroenterology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK
- University of East Anglia, Norwich, Norfolk, UK
| | | | - Nicholas I Church
- Department of Gastroenterology, NHS Lothian, Edinburgh, Edinburgh, UK
| | - Elizabeth Ratcliffe
- Faculty of Medical and Human Sciences, The University of Manchester, Manchester, Manchester, UK
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, Wigan, UK
| | - Said Din
- Department of Gastroenterology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Rupert D Pullan
- Colorectal Surgery, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
| | - Sharon Powell
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Catherine Regan
- Endoscopy, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
| | - Wee Sing Ngu
- Colorectal Surgery, City Hospitals Sunderland NHS Foundation Trust, South Shields, Tyne and Wear, UK
| | - Eleanor Wood
- Department of Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, London, UK
| | - Sarah Mills
- Colorectal Surgery, Chelsea and Westminster Hospital, London, UK
- Imperial College London, London, UK
| | - Neil Hawkes
- Department of Gastroenterology, Royal Glamorgan Hospital, Llantrisant, UK
| | - Paul Dunckley
- Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, Gloucestershire, UK
| | - Marietta Iacucci
- University of Birmingham College of Medical and Dental Sciences, Birmingham, Birmingham, UK
- Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, UK
| | - Siwan Thomas-Gibson
- Imperial College London, London, UK
- St Mark's Hospital and Academic Institute Wolfson Unit for Endoscopy, Harrow, London, UK
| | - Christopher Wells
- Department of Gastroenterology, North Tees and Hartlepool NHS Foundation Trust, Hartlepool, Hartlepool, UK
| | - Aravinth Murugananthan
- Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, Wolverhampton, UK
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
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Horii T, Suzuki S, Sugita A, Yamauchi M, Ikehara H, Kusano C, Gotoda T. Comparison of complete resection rates in cold snare polypectomy using two different wire diameter snares: A randomized controlled study. J Gastroenterol Hepatol 2022; 38:752-760. [PMID: 36565225 DOI: 10.1111/jgh.16092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/02/2022] [Accepted: 12/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND AIM Cold snare polypectomy (CSP) is a standard treatment for small colorectal polyps. This study examined the effect of different snare wire diameters on complete histological resection rate, resection depth, and CSP safety. METHODS This randomized controlled trial was conducted at two institutions between June 2019 and March 2021. Eligible colorectal polyps (≤10 mm) were randomly assigned in a 1:1 ratio to receive either CSP with a conventional snare made of normal-diameter wire (0.40 mm) or CSP with a dedicated snare made of thin wire (0.23 mm). The primary endpoint was the complete resection rate determined on histological assessment of the resected specimen. RESULTS In total, 254 lesions in 152 patients were included, with 128 and 126 lesions assigned to the normal-diameter wire snare group and the thin-wire snare group, respectively. No significant differences were observed in patient characteristics between the two groups. The histological complete resection rate was significantly higher in the thin-wire snare group than in the normal-diameter wire snare group (70.0% vs 81.0%, P = 0.04). The normal-diameter wire snare group had significantly more cases of unclear horizontal margin evaluation than the thin-wire snare group (28.1% vs 15.9%, P = 0.02). No significant differences were observed between the two groups in the muscularis mucosa and submucosa of the resected specimens or the thickness of the submucosa in the resected specimens. CONCLUSIONS CSP with a dedicated thin-wire snare provides more specimens that can be evaluated at the horizontal end and increases the histological complete resection rate.
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Affiliation(s)
- Toshiki Horii
- Department of Gastroenterology, Kitasato University of Medicine, Sagamihara, Kanagawa, Japan
| | - Sho Suzuki
- Department of Gastroenterology, International University of Health and Welfare Ichikawa Hospital, Ichikawa-shi, Chiba, Japan
| | - Akihiro Sugita
- Department of Pathology, Yuri Kumiai General Hospital, Yurihonjo, Akita, Japan
| | - Misa Yamauchi
- Department of Pathology, Yuri Kumiai General Hospital, Yurihonjo, Akita, Japan
| | - Hisatomo Ikehara
- Department of Gastroenterology, Kitasato University of Medicine, Sagamihara, Kanagawa, Japan
| | - Chika Kusano
- Department of Gastroenterology, Kitasato University of Medicine, Sagamihara, Kanagawa, Japan
| | - Takuji Gotoda
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
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18
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Ko CY, Yao CC, Li YC, Lu LS, Chou YP, Hu ML, Chiu YC, Chuah SK, Tai WC. Clinical outcomes of endoscopic submucosal dissection for colorectal neoplasms: A single-center experience in Southern Taiwan. PLoS One 2022; 17:e0275723. [PMID: 36206286 PMCID: PMC9543958 DOI: 10.1371/journal.pone.0275723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Background and aims Endoscopic submucosal dissection (ESD) as an advanced endoscopic procedure can be considered for the removal of colorectal lesions with high suspicion of limited submucosal invasion or cannot be optimally removed by snare-based techniques. We aimed to analyze the clinical outcomes of ESD for colorectal neoplasms in our hospital. Methods We retrospectively enrolled 230 patients with 244 colorectal neoplasms who received ESD procedures from April 2012 to October 2020 at Kaohsiung Chang Gung Memorial Hospital. Clinicopathological data were collected by chart review. We also recorded ESD-related complications and clinical outcomes. Results The average age was 64 years old, with a mean follow-up time of 22.59 months. There was a loss of follow-up in 34 lesions. Most lesions were lateral spreading tumors of the non-granular type. The average ESD time was 51.9 minutes. Nine cases (3.7%) had procedure-related complications, including two intra-procedure perforations (0.8%) and seven delayed bleeding (2.9%) without procedure-related mortality. 241 lesions (98.8%) achieved en-bloc resection, while 207 lesions (84.8%) achieved R0 resection. Most lesions were tubulo-(villous) adenoma. Malignancy included 35 adenocarcinomas and 5 neuroendocrine tumors. No local recurrence was developed during follow-up. Multivariate analysis for long ESD time revealed significance in size ≥ 10 cm2 and endoscopist’s experience < 3 years. Pre-ESD endoscopic ultrasound revealed good prediction in discrimination of mucosal (sensitivity: 0.90) and submucosal lesion (specificity: 0.67). Conclusions ESD for colorectal neoplasms is an effective and safe technique. Size ≥ 10 cm2 and endoscopist’s experience < 3 years were significantly associated with long procedure time. Pre-ESD EUS provided a good prediction for colorectal neoplasms in invasion depth.
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Affiliation(s)
- Chen-Yu Ko
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Chien Yao
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chi Li
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Lung-Sheng Lu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yeh-Pin Chou
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Ming-Luen Hu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Chiu
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Seng-Kee Chuah
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chen Tai
- Division of Hepato-Gastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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19
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Issues and Prospects of Current Endoscopic Treatment Strategy for Superficial Non-Ampullary Duodenal Epithelial Tumors. Curr Oncol 2022; 29:6816-6825. [PMID: 36290814 PMCID: PMC9600730 DOI: 10.3390/curroncol29100537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/11/2022] [Accepted: 09/20/2022] [Indexed: 01/13/2023] Open
Abstract
An increasing number of duodenal tumors are being diagnosed over the years, leading to increased confusion regarding the choice of treatment options. Small-to-large tumors and histological types vary from adenoma to carcinoma, and treatment methods may need to be selected according to lesion characteristics. Because of its anatomic characteristics, complications are more likely to occur in the duodenum than in other gastrointestinal organs. Several reports have described the outcomes of conventional endoscopic mucosal resection, endoscopic submucosal dissection, cold snare polypectomy, underwater endoscopic mucosal resection, endoscopic full-thickness resection, and laparoscopic and endoscopic cooperative surgery for duodenal tumors. However, even in the guidelines set out by various countries, only the treatment methods are listed, and no clear treatment strategies are provided. Although there are few reports with a sufficiently high level of evidence, considering the currently available treatment options is essential. In this report, we reviewed previous reports on each treatment strategy, discussed the current issues and prospects, and proposed the best possible treatment strategy.
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Myung YS, Kwon H, Han J, Lim J, Choi SY, Baeg MK, Han SW. Underwater versus conventional cold snare polypectomy of colorectal polyps 4-9 mm in diameter: a prospective randomized controlled trial. Surg Endosc 2022; 36:6527-6534. [PMID: 35024932 DOI: 10.1007/s00464-022-09013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Cold snare polypectomy (CSP) has been reported as safe and effective method for the removal of small colorectal polyps. However, some studies showed low R0 resection rate. Underwater endoscopic mucosal resection is an effective technique to increase the proportions of complete resection. Therefore, the aim was to compare the rate of R0 resection of colorectal polyps 4-9 mm in diameter between conventional CSP (C-CSP) and underwater CSP (U-CSP). METHODS This study was a prospective randomized controlled trial. A total of 198 polyps (4-9 mm) in 110 patients were enrolled between December 2019 and June 2020. The polyps were randomized to be treated with either C-CSP (100 polyps) or U-CSP (98 polyps). RESULTS The R0 resection rate was significantly higher in U-CSP group than in C-CSP groups (84.7% vs. 59.0%; p < 0.001). The polyp retrieval rate of C-CSP and U-CSP was 94.5% and 100% (p = 0.030). The rate of polyp fragmentation of C-CSP and U-CSP group was 5.3% and 0% (p = 0.027). The resection time and retrieval time were longer in C-CSP than U-CSP (45.0 ± 37.7 s vs. 34.1 ± 21.2 s, p = 0.032 and 51.9 ± 67.7 s vs. 12.7 ± 12.4 s, p < 0.001). No clinically significant bleeding or perforation occurred in either group. CONCLUSIONS The results of this study were excellent with U-CSP of 4-9 mm colorectal polyps in terms of R0 resection, polyp retrieval and fragmentation rate, and procedure/retrieval time. Therefore, U-CSP is a safe and effective technique for removing colorectal polyps 4-9 mm in diameter. KCT (0004530).
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Affiliation(s)
- Yu Sik Myung
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea.
| | - Hyuki Kwon
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Jaeho Han
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Jongreul Lim
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Soo Yong Choi
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Myong Ki Baeg
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
| | - Sok Won Han
- Gastroenterology, Department of Internal Medicine, International St. Mary's Hospital, Catholic Kwandong University of Medicine, 100Gil 25 Simgok-ro, Seo-gu, Inchon, 22711, Korea
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21
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Auriemma F, Sferrazza S, Bianchetti M, Savarese MF, Lamonaca L, Paduano D, Piazza N, Giuffrida E, Mete LS, Tucci A, Milluzzo SM, Iannelli C, Repici A, Mangiavillano B. From advanced diagnosis to advanced resection in early neoplastic colorectal lesions: Never-ending and trending topics in the 2020s. World J Gastrointest Surg 2022; 14:632-655. [PMID: 36158280 PMCID: PMC9353749 DOI: 10.4240/wjgs.v14.i7.632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/02/2021] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Colonoscopy represents the most widespread and effective tool for the prevention and treatment of early stage preneoplastic and neoplastic lesions in the panorama of cancer screening. In the world there are different approaches to the topic of colorectal cancer prevention and screening: different starting ages (45-50 years); different initial screening tools such as fecal occult blood with immunohistochemical or immune-enzymatic tests; recto-sigmoidoscopy; and colonoscopy. The key aspects of this scenario are composed of a proper bowel preparation that ensures a valid diagnostic examination, experienced endoscopist in detection of preneoplastic and early neoplastic lesions and open-minded to upcoming artificial intelligence-aided examination, knowledge in the field of resection of these lesions (from cold-snaring, through endoscopic mucosal resection and endoscopic submucosal dissection, up to advanced tools), and management of complications.
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Affiliation(s)
- Francesco Auriemma
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Sandro Sferrazza
- Gastroenterology and Endoscopy Unit, Santa Chiara Hospital, Trento 38014, Italy
| | - Mario Bianchetti
- Digestive Endoscopy Unit, San Giuseppe Hospital - Multimedica, Milan 20123, Italy
| | - Maria Flavia Savarese
- Department of Gastroenterology and Gastrointestinal Endoscopy, General Hospital, Sanremo 18038, Italy
| | - Laura Lamonaca
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Danilo Paduano
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza 21053, Italy
| | - Nicole Piazza
- Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese; Department of Biomedical Sciences for Health, University of Milan, Milan 20122, Italy
| | - Enrica Giuffrida
- Gastroenterology and Hepatology Unit, A.O.U. Policlinico “G. Giaccone", Palermo 90127, Italy
| | - Lupe Sanchez Mete
- Department of Gastroenterology and Digestive Endoscopy, IRCCS Regina Elena National Cancer Institute, Rome 00144, Italy
| | - Alessandra Tucci
- Department of Gastroenterology, Molinette Hospital, Città della salute e della Scienza di Torino, Turin 10126, Italy
| | | | - Chiara Iannelli
- Department of Health Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Alessandro Repici
- Digestive Endoscopy Unit and Gastroenterology, Humanitas Clinical and Research Center and Humanitas University, Rozzano 20089, Italy
| | - Benedetto Mangiavillano
- Biomedical Science, Hunimed, Pieve Emanuele 20090, Italy
- Gastrointestinal Endoscopy Unit, Humanitas Mater Domini, Castellanza, Varese 21053, Italy
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22
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Meng QQ, Rao M, Gao PJ. Effect of cold snare polypectomy for small colorectal polyps. World J Clin Cases 2022; 10:6446-6455. [PMID: 35979305 PMCID: PMC9294897 DOI: 10.12998/wjcc.v10.i19.6446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colorectal cancer remains a considerable challenge in healthcare nowadays. Approximately 60%-80% of colorectal cancer is caused by intestinal polyps, and resection of intestinal polyps has been proved to reduce the incidence of colorectal cancer. The vast majority of intestinal polyps can be found during colonoscopy and removed endoscopically. Therefore, more attention has been paid to the development of endoscopic resection of intestinal polyps. In this study, we compared the efficacy and safety of cold snare polypectomy (CSP) and hot snare polypectomy (HSP).
AIM To investigate the efficacy and safety of CSP and HSP for colorectal polyps.
METHODS Between January and December 2020, 301 patients with colorectal polyps 4-9 mm in diameter were treated with endoscopic therapy in our hospital, and were divided into the CSP group (n = 154) and HSP group (n = 147). The operating time, incidence of bleeding and perforation, use of titanium clips, and complete resection rate were compared between the two groups.
RESULTS We included 249 patients (301 polyps). No differences in gender, age, and polyp size, location, shape and type were observed between the CSP and HSP groups, and the resection rates in these two groups were 93.4% and 94.5%, respectively, with no significant difference. The use of titanium clips was 15.6% and 95.9%, the operating time was 3.2 ± 0.5 min and 5.6 ± 0.8 min, the delayed bleeding rate was 0% and 2.0%, and delayed perforation was 0% and 0.7%, in the CSP and HSP groups, respectively.
CONCLUSION For sessile colorectal polyps < 10 mm, CSP had the same resection rate of impaired tissue integrity as traditional HSP had. The rate of complications was lower in the CSP group. CSP is a safe and effective method for polypectomy.
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Affiliation(s)
- Qing-Qing Meng
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Min Rao
- Department of Hepatology and Gastroenterology, The Second Part of First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Pu-Jun Gao
- Department of Hepatology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
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23
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Yoshida N, Hashimoto H, Inoue K, Kobayashi R, Tomita Y, Sugino S, Hirose R, Dohi O, Morinaga Y, Inada Y, Murakami T, Itoh Y. Repeat Cold Snare Polypectomy Can Be Performed for Recurrent Benign Lesions After Cold Snare Polypectomy. Dig Dis Sci 2022; 67:3192-3199. [PMID: 34731360 DOI: 10.1007/s10620-021-07292-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Recurrence after cold snare polypectomy (CSP) sometimes occurs. We assessed the feasibility of repeat CSP for recurrence after CSP. METHODS We retrospectively reviewed recurrent lesions after CSP which were resected by repeat CSP from 2016 to 2021 in our institution and analyzed clinical outcomes of repeat CSP, comparing those of non-recurrent 454 lesions receiving standard CSP in 2016 and follow-up colonoscopy. We also analyzed the recurrent rate among cases receiving follow-up in both groups. Indication of repeat CSP was lesions diagnosed as benign tumors of ≤ 10 mm. RESULTS We analyzed 80 lesions receiving repeat CSP. The polyp size (mean ± standard deviation: SD) was 4.1 ± 2.3 mm (range 2-10 mm). The right-sided colon and non-polypoid morphology rates were 66.3% and 43.8%, respectively. Histopathological diagnosis was 66 adenomas, 12 sessile serrated lesions (SSLs), 1 SSL with dysplasia, and 1 high-grade dysplasia. The procedure time (min, mean ± SD) of repeat CSP was 0.9 ± 0.8. Regarding the comparison of repeat CSP/ standard CSP group, the en bloc resection and histopathological complete resection rates were 78.8%/ 98.0% (p < 0.001) and 43.8%/59.6% (p = 0.007) and the rates of perioperative hemorrhage requiring endoscopic clipping were 1.3%/ 1.0% (p = 0.646). There were no postoperative hemorrhage and perforation in both groups (p = 1.0). Among lesions receiving follow-up colonoscopy, the mean recurrence rates (number, median follow-up period: interquartile) of repeat CSP and standard CSP group were 2.0% (1/50, 12 months: 12-24) versus 0.7% (3/454, 12 months: 12-24) (p = 0.862). CONCLUSIONS Repeat CSP for benign recurrent lesions after CSP was safe and feasible.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Reo Kobayashi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoshi Sugino
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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24
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Ikeda T, Yoshizaki T, Eguchi T, Kinugasa H, Okada A. Efficacy of specimen pasting after cold snare polypectomy for pathological evaluation of horizontal margins. Endosc Int Open 2022; 10:E572-E579. [PMID: 35571463 PMCID: PMC9106410 DOI: 10.1055/a-1784-6723] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/03/2022] [Indexed: 02/07/2023] Open
Abstract
Background and study aims Several studies have reported that pathological horizontal margin evaluation cannot be diagnosed in cold snare polypectomy (CSP) specimens. We conducted a prospective randomized controlled trial to determine the efficacy of pasting CSP specimens on paper for pathological horizontal margins. Patients and methods This was a single-center, prospective study conducted at Osaka Saiseikai Nakatsu Hospital. In this study, the indications for CSP were adenomas ≤ 10 mm. Colorectal polyps resected by CSP were randomized to the pasting and non-pasting groups after exclusion of fragmented specimens, and the extended CSP specimens pasted on paper were formalin-fixed in the pasting group. The primary endpoint was rate of unclear horizontal margins after CSP. Results A total of 216 CSP specimens were analyzed. The rate of unclear horizontal margins was significantly lower in the pasting group than in the non-pasting group (15.1 % vs 33.6 %, P = 0.002). CSP specimen pasting significantly reduced the rate of unclear horizontal margins. On multivariate analysis, non-pasting group (odds ratio [OR], 2.69; 95 % confidence interval [CI], 1.38-5.41; P = 0.003) and right colon (OR, 1.98; 95 %CI, 1.01-4.01; P = 0.047) were independent risk factors for unclear horizontal margins in CSP specimens. Conclusions Pasting the extended specimen is important for accurate pathological examination after CSP.
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Affiliation(s)
- Takuya Ikeda
- Department of Clinical laboratory Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tetsuya Yoshizaki
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan,Department of Gastroenterology Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takaaki Eguchi
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hiroshi Kinugasa
- Department of Clinical laboratory Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Akihiko Okada
- Department of Gastroenterology Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
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Messmann H, Probst A, Ebigbo A. Endoscopic Characterization of Colorectal Lesions and Resection Strategy. GASTROINTESTINAL AND PANCREATICO-BILIARY DISEASES: ADVANCED DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2022:311-327. [DOI: 10.1007/978-3-030-56993-8_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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26
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Takeuchi Y, Shichijo S, Uedo N, Kawakami Y, Okubo Y, Tani Y, Sakurai H, Nakamura T, Miyake M, Matsueda K, Ishihara R. Safety and efficacy of cold versus hot snare polypectomy including colorectal polyps ≥1 cm in size. Dig Endosc 2022; 34:274-283. [PMID: 34324730 DOI: 10.1111/den.14096] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/26/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022]
Abstract
Cold snare polypectomy (CSP; polypectomy without electrocautery) has spread rapidly worldwide during the past decade in what has been called "Cold Revolution". We performed a PubMed literature search for studies investigating CSP outcomes for colorectal polyps. Five randomized controlled trials (RCTs) assessed the complete resection rates (CRRs). The CRRs were similar regardless of the presence or absence of electrocautery, and the efficacy of submucosal injection for better CRRs is still controversial. Eight RCTs assessed the adverse events. The incidence of intraprocedural bleeding with cold procedures was comparable to or higher than that of hot procedures. The incidences of delayed bleeding were comparable to or lower with cold procedures, especially in patients taking anticoagulants. Fifteen studies have been reported on CSP for large (≥1 cm) colorectal polyps (10 retrospective studies, four prospective single-arm studies, and one prospective RCT). These studies reported that the safe cold procedures (a low intra- and post-procedural bleeding rate without perforation) could be implemented for lesions ≥1 cm. However, considering the incision depth of CSP and the local recurrence rate based on the current evidence, only large sessile serrated lesions (SSLs) can be candidates for cold procedures, and large adenomas should not be candidates for this procedure. Based on the current evidence, CSP seems to be the appropriate standard procedure for sub-centimeter colorectal low-grade adenomas due to its safety and simplicity. Thus, large SSLs can be candidates for cold procedures; however, careful inspection and further prospective studies are warranted to confirm the procedure's clinical relevance.
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Affiliation(s)
- Yoji Takeuchi
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoki Shichijo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Noriya Uedo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yushi Kawakami
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yuki Okubo
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuhiro Tani
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hirohisa Sakurai
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiko Nakamura
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Muneaki Miyake
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Katsunori Matsueda
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
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Saito M, Yamamura T, Nakamura M, Maeda K, Sawada T, Ishikawa E, Mizutani Y, Ishikawa T, Kakushima N, Furukawa K, Ohno E, Kawashima H, Ishigami M, Fujishiro M. Real-world local recurrence rate after cold polypectomy in colorectal polyps less than 10 mm using propensity score matching. World J Gastroenterol 2021; 27:8182-8193. [PMID: 35068862 PMCID: PMC8704276 DOI: 10.3748/wjg.v27.i47.8182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/15/2021] [Accepted: 12/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cold polypectomy (CP) is a simple and safe procedure for polyps less than 10 mm in size; however, there is concern about local recurrence following CP because of unidentified margins of excised specimens and the lack of tumor suppression effect by coagulation. Some clinical trials have evaluated local persistent recurrence; their results suggest that a higher rate of local recurrence has not been documented so far. There were few reports that observed the course over long periods of time after CP in clinical practice. AIM To evaluate the presence of local recurrence following CP and hot polypectomy (HP) using propensity score matching. METHODS We analyzed 275 patients who underwent polypectomy for non-pedunculated colorectal polyps less than 10 mm (959 Lesions) between October 2016 and 2017 and underwent follow-up endoscopy subsequently. We divided them into the CP group (706 Lesions), wherein CP was performed, and the HP group (253 Lesions), wherein HP was performed. Using propensity score matching, we extracted 215 Lesions in each group and evaluated the local recurrence and content of CP in the real clinic and adverse events using medical records. RESULTS After propensity score matching, there were no significant differences in the patients' and their endoscopic background (age, use of antithrombotics, indications, size, morphology, location of polyps, and polypectomy device) between the groups. The mean duration between colorectal polypectomy and the next follow-up colonoscopy was 17.5 ± 7.1 (range, 6-39) mo in the CP group and 15.7 ± 6.0 (range, 6-35) mo in the HP group, which was significantly longer in the CP group (P = 0.005). The local recurrence rate was 0.93% in the CP group and 0.93% in the HP group, without a significant difference (P = 0.688). Additionally, no differences were observed in the macroscopic en bloc resection rate, histopathological complete resection rate, and pathological results between the groups. Adverse events did not occur in either group. CONCLUSION Local recurrence after CP was equivalent to that following HP in clinical practice. CP is useful and safe in the treatment of non-pedunculated polyps of less than 10 mm.
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Affiliation(s)
- Masashi Saito
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Keiko Maeda
- Department of Endoscopy, Nagoya University Hospital, Nagoya 4668550, Japan
| | - Tsunaki Sawada
- Department of Endoscopy, Nagoya University Hospital, Nagoya 4668550, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Hiroki Kawashima
- Department of Endoscopy, Nagoya University Hospital, Nagoya 4668550, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya 4668550, Japan
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Yoshida N, Fukumoto K, Hasegawa D, Inagaki Y, Inoue K, Hirose R, Dohi O, Ogiso K, Murakami T, Tomie A, Okuda K, Inada Y, Okuda T, Rani RA, Morinaga Y, Kishimoto M, Itoh Y. Recurrence rate and lesions characteristics after cold snare polypectomy of high-grade dysplasia and T1 lesions: A multicenter analysis. J Gastroenterol Hepatol 2021; 36:3337-3344. [PMID: 34260116 DOI: 10.1111/jgh.15625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/28/2021] [Accepted: 07/06/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIM High-grade dysplasia (HGD) and T1 lesions are accidentally resected by cold snare polypectomy (CSP) and the characteristics, and follow-up of them has not been reported. In this study, we analyzed the histopathological findings and recurrence of them. METHODS This was a multicenter retrospective-cohort study. We collected HGD and T1 lesions of ≤ 10 mm resected by CSP among 15 520 patients receiving CSP from 2014 to 2019 at nine related institutions, and we extracted only cases receiving definite follow-up colonoscopy after CSP of HGD and T1 lesions. We analyzed these tumor's characteristics and therapeutic results such as R0 resection and local recurrence and risk factors of recurrence. RESULTS We collected 103 patients (0.63%) and extracted 80 lesions in 74 patients receiving follow-up colonoscopy for CSP scar. Mean age was 68.4 ± 12.0, and male rate was 68.9% (51/80). The mean tumor size (mm) was 6.6 ± 2.5, and the rate of polypoid morphology and rectum location was 77.5% and 25.0%. The rate of magnified observation was 53.8%. The rates of en bloc resection and R0 resection were 92.5% and 37.5%. The local recurrence rate was 6.3% (5/80, median follow-up period: 24.0 months). The recurrence developed within 3 months after CSP for four out of five recurrent cases. Comparing five recurrent lesions to 75 non-recurrent lesions, a positive horizontal margin was a significant risk factor (60.0% vs 10.7%, P < 0.001). CONCLUSIONS High-grade dysplasia and T1 resected by CSP were analyzed, and the local recurrence rate of them was substantially high.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
- Department of Gastroenterology, Nishijin Hospital, Kyoto, Japan
| | - Kohei Fukumoto
- Department of Gastroenterology, Nara City Hospital, Nara, Japan
| | - Daisuke Hasegawa
- Department of Gastroenterology, Ayabe City Hospital, Kyoto, Japan
| | | | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Kiyoshi Ogiso
- Department of Gastroenterology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Takaaki Murakami
- Department of Gastroenterology, Japan Community Health Care Organization, Kyoto Kuramaguchi Medical Center, Kyoto, Japan
| | - Akira Tomie
- Department of Gastroenterology, Saiseikai Kyoto Hospital, Kyoto, Japan
| | - Kotaro Okuda
- Department of Gastroenterology, Kyoto Kujo Hospital, Kyoto, Japan
| | - Yutaka Inada
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Takashi Okuda
- Department of Gastroenterology, Fukuchiyama City Hospital, Kyoto, Japan
| | - Rafiz Abdul Rani
- Gastroenterology Unit, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - Yukiko Morinaga
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuo Kishimoto
- Department of Surgical Pathology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Oka K, Inada Y, Okuda T, Yoshida N. Rapid progression of residual rectal cancer after cold snare polypectomy. Ann Gastroenterol 2021; 34:892. [PMID: 34815658 PMCID: PMC8596220 DOI: 10.20524/aog.2021.0669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/13/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Kohei Oka
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama-City (Kohei Oka, Takashi Okuda)
| | - Yutaka Inada
- Department of Gastroenterology and Hepatology, Japanese Red Cross Kyoto Daiichi Hospital (Yutaka Inada)
| | - Takashi Okuda
- Department of Gastroenterology and Hepatology, Fukuchiyama City Hospital, Fukuchiyama-City (Kohei Oka, Takashi Okuda)
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine (Naohisa Yoshida), Kyoto, Japan
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30
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Yuan X, Gao H, Liu C, Cui H, Zhang Z, Xie J, Lu H, Xu L. Effectiveness and safety of the different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps: A systematic review and pooled analysis. Saudi J Gastroenterol 2021; 27:331-341. [PMID: 34643573 PMCID: PMC8656331 DOI: 10.4103/sjg.sjg_180_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND We performed a systematic review and pooled analysis to assess the effectiveness and safety of different endoscopic resection methods for 10- to 20-mm nonpedunculated colorectal polyps. METHODS Articles in PubMed, EMBASE, and the Cochrane Library related to the common endoscopic treatment of 10- to 20-mm nonpedunculated polyps published as of April 2020 were searched. Primary outcomes were the R0 resection rate and en bloc resection rate. Secondary outcomes were safety and the recurrence rate. Meta-regression and subgroup analysis were also performed. RESULTS A total of 36 studies involving 3212 polyps were included in the final analysis. Overall, the effectiveness of resection methods with a submucosal uplifting effect, including endoscopic mucosal resection (EMR), cold EMR and underwater EMR (UEMR), was better than that of methods without a nonsubmucosal uplifting effect [R0 resection rate, 90% (95% confidence interval (CI) 0.81-0.94, I2 = 84%) vs 82% (95% CI 0.78-0.85, I2 = 0%); en bloc resection rate 85% (95% CI 0.79-0.91, I2 = 83%) vs 74% (95% CI 0.47-0.94, I2 = 94%)]. Regarding safety, the pooled data showed that hot resection [hot snare polypectomy, UEMR and EMR] had a higher risk of intraprocedural bleeding than cold resection [3% (95% CI 0.01-0.05, I2 = 68%) vs 0% (95% CI 0-0.01, I2 = 0%)], while the incidences of delayed bleeding, perforation and post-polypectomy syndrome were all low. CONCLUSIONS Methods with submucosal uplifting effects are more effective than those without for resecting 10- to 20-mm nonpedunculated colorectal polyps, and cold EMR is associated with a lower risk of intraprocedural bleeding than other methods. Additional research is needed to verify the advantages of these methods, especially cold EMR.
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Affiliation(s)
- Xin Yuan
- School of Medicine, Ningbo University, Ningbo First Hospital, Zhejiang, China
| | - Hui Gao
- School of Medicine, Ningbo University, Ningbo First Hospital, Zhejiang, China
| | - Cenqin Liu
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Hongyao Cui
- Department of Gastroenterology, Haishu Second Hospital, Zhejiang, China
| | - Zhixin Zhang
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Jiarong Xie
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Hongpeng Lu
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China
| | - Lei Xu
- Department of Gastroenterology, Ningbo First Hospital, Zhejiang, China,Address for correspondence: Dr. Lei Xu, Department of Gastroenterology, Ningbo First Hospital. No. 59 Liuting Street, Ningbo - 315010, China. E-mail:
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31
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Ortigão R, Weigt J, Afifi A, Libânio D. Cold versus hot polypectomy/endoscopic mucosal resection-A review of current evidence. United European Gastroenterol J 2021; 9:938-946. [PMID: 34355525 PMCID: PMC8498395 DOI: 10.1002/ueg2.12130] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/01/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Colonoscopy with polypectomy substantially reduces the risk of colorectal cancer (CRC) but interval cancers still account for 9% of all CRCs, some of which are due to incomplete resection. AIM The aim of this review is to compare the outcomes of cold and hot endoscopic resection and provide technical tips and tricks for optimizing cold snare polypectomy. RESULTS Cold snare polypectomy (CSP) is the standard technique for small (≤10 mm) colorectal polyps. For large colonic polyps (>10 mm), hot resection techniques with use of electrocautery (polypectomy or endoscopic mucosal resection) were recommended until recently. However, the use of electrocoagulation brings serious adverse effects in up to 9% of the patients, such as delayed bleeding, post-polypectomy syndrome and perforation. In recent years, efforts have been made to improve the polypectomy with cold snare in order to avoid these adverse effects of electrocoagulation without compromising the efficacy of the resection. Several authors have recently shown that the complication rates of CSP of polyps >10 mm is close to zero and recurrence rates varies between 5-18%. Lower recurrence rates are found in serrated lesions (<8%).
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Affiliation(s)
- Raquel Ortigão
- Gastroenterology DepartmentPortuguese Oncology Institute of PortoPortugal
| | - Jochen Weigt
- Gastroenterology Department, Hepatology and Infectious DiseasesOtto‐v.‐Guericke UniversityMagdeburgGermany
| | - Ahmed Afifi
- Gastroenterology Department, Hepatology and Infectious DiseasesOtto‐v.‐Guericke UniversityMagdeburgGermany
| | - Diogo Libânio
- Gastroenterology DepartmentPortuguese Oncology Institute of PortoPortugal
- MEDCIDS–Department of Community Medicine, Health Information and DecisionFaculty of MedicineUniversity of PortoPortoPortugal
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Yamasaki Y, Harada K, Yamamoto S, Yasutomi E, Hirai M, Ohmori M, Oka S, Inokuchi T, Kinugasa H, Sugihara Y, Takahara M, Hiraoka S, Tanaka T, Mitsuhashi T, Okada H. Evaluation of complete cold forceps polypectomy resection rate for 3- to 5-mm colorectal polyps. Dig Endosc 2021; 33:948-954. [PMID: 33211353 DOI: 10.1111/den.13895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND STUDY AIMS The propriety of cold forceps polypectomy (CFP) using jumbo biopsy forceps for diminutive polyps remains controversial. We conducted a prospective study to evaluate the complete CFP resection rate of 3-5-mm polyps using additional endoscopic mucosal resection (EMR) specimens following CFP. PATIENTS AND METHODS Patients with 3-5-mm protruded or flat elevated colorectal polyps diagnosed endoscopically as adenomas or serrated lesions were prospectively enrolled. CFP using jumbo biopsy forceps was used to remove the eligible polyps and repeated until the absence of residuals were confirmed via image-enhanced endoscopy or chromoendoscopy. After CFP, saline was injected at the defect, and the marginal specimen of the defect was resected using EMR to histologically evaluate the residue. The primary outcome was the complete CFP resection rate, which was defined as no residue at the EMR site. Other outcomes were the number of CFP bites and the complete resection rate by lesion size. RESULTS Eighty patients with 120 polyps were enrolled. The mean polyp size was 4.1 ± 0.7 mm. The overall complete resection rate was 96.7% (95% confidence interval [CI], 91.7-98.7), and the rates for 3-, 4- and 5-mm polyps were 100% (95% CI, 86.7-100), 96.0% (95% CI, 86.5-98.9) and 95.5% (95% CI, 85.1-98.8), respectively. The one-bite CFP rates were 92%, 60% and 31% for the 3-, 4- and 5-mm polyps, respectively. CONCLUSIONS The complete CFP resection rate for 3-5-mm polyps was acceptable, although the one-bite clearance rate decreased as the polyp size increased (UMIN000028841).
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Affiliation(s)
- Yasushi Yamasaki
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Keita Harada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Shumpei Yamamoto
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Eriko Yasutomi
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Mami Hirai
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Masayasu Ohmori
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Shohei Oka
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Toshihiro Inokuchi
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Hideaki Kinugasa
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Yuusaku Sugihara
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Masahiro Takahara
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Sakiko Hiraoka
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
| | - Takehiro Tanaka
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Toshiharu Mitsuhashi
- Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Okada
- Department of Gastroenterology, Okayama University Hospital, Okayama, Japan
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Fukushima H, Sakamoto N, Shibuya T, Haga K, Nomura O, Murakami T, Ueyama H, Ishikawa D, Hojo M, Nagahara A. A Comparative Study of Early Mucosal Healing Following Hot Polypectomy and Cold Polypectomy. Med Sci Monit 2021; 27:e933043. [PMID: 34432770 PMCID: PMC8404476 DOI: 10.12659/msm.933043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cold polypectomy (CP) and hot polypectomy (HP) are both accepted methods for polypectomy. In recent years, the use of CP has increased for reasons of safety. However, there have been few investigations of conditions at follow-up early after resection. This prospective study from a single center aimed to compare colonic mucosal healing at 1 week following HP vs CP of benign colonic polyps <10 mm in diameter. MATERIAL AND METHODS Six patients with a total of 52 lesions under 10 mm in size were randomized to either the HP group (n=25) or CP group (n=27) using information in opaque envelopes. One week after endoscopic treatment, the site of treatment was evaluated using colonoscopy. We assessed the mean tumor size, ulcer diameter, exposed blood vessels, residual lesion, and complications. RESULTS Mean tumor size did not differ between the 2 groups (CP vs HP: 5.41 mm vs 5.68 mm). The CP group had a smaller ulcer base diameter (2.70 mm vs 4.84 mm; P<0.05) and fewer exposed blood vessels than the HP group (3.7% vs 36.0%; P<0.05). One residual lesion was found in the CP group. No patients experienced delayed perforation or post-polypectomy bleeding. CONCLUSIONS Our study findings showed that at 1-week follow-up, cold polypectomy resulted in improved colonic mucosal healing, with a smaller ulcer diameter and fewer blood vessels, when compared with hot polypectomy.
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Zimmer V. Pressurized submucosal water infusion as a novel endoscopic principle to optimize defect margin assessment after cold snare mucosectomy. Clin Res Hepatol Gastroenterol 2021; 45:101642. [PMID: 33857738 DOI: 10.1016/j.clinre.2021.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 01/16/2021] [Indexed: 02/04/2023]
Affiliation(s)
- V Zimmer
- Department of Medicine, Marienhausklinik St. Josef Kohlhof, Neunkirchen, Germany; Department of Medicine II, Saarland University Medical Center, Saarland University Homburg, Germany.
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35
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Kitae H, Yoshida N, Inoue K. Cancer recurrence with severe fibrosis after cold snare polypectomy resected by means of endoscopic submucosal dissection. Endoscopy 2021; 53:E187-E188. [PMID: 32882735 DOI: 10.1055/a-1234-5963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Hiroaki Kitae
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohisa Yoshida
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ken Inoue
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Yoshida N, Inoue K, Tomita Y, Hashimoto H, Sugino S, Hirose R, Dohi O, Naito Y, Morinaga Y, Kishimoto M, Inada Y, Murakami T, Itoh Y. Cold snare polypectomy for large sessile serrated lesions is safe but follow-up is needed: a single-centre retrospective study. United European Gastroenterol J 2021; 9:370-377. [PMID: 33045938 PMCID: PMC8259250 DOI: 10.1177/2050640620964641] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/17/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIM Cold snare polypectomy (CSP) is growing in popularity due to its safety and convenience. Its indication is benign tumours such as adenoma and sessile serrated lesions (SSLs) <10 mm in size. CSP for SSLs ≥10 mm in size has not been well examined. In this study, we aimed the feasibility of this treatment regarding therapeutic results and local recurrence. METHODS This was a single-centre retrospective cohort study. We reviewed SSLs with or without dysplasia of 10-20 mm that were resected by CSP from 2014 to 2020. All tumours were diagnosed endoscopically as SSLs without dysplasia before CSP with the help of magnifying narrow band imaging or blue laser imaging. We analysed the lesion characteristics, en bloc resection, histopathological diagnosis, adverse events and local recurrence. We analysed risk factors for recurrence, comparing recurrent lesions to non-recurrent lesions. We also compared risk factors for lesions 10-14 mm in size to those for lesions 15-20 mm in size. RESULTS We analysed 160 lesions in 100 patients (Mage ± SD = 67.7 ± 10.1 years). The polyp size (M ± SD) was 11.8 ± 2.8 mm, and the en bloc resection rate was 60.0% (96 cases). The rates of massive perioperative haemorrhage, postoperative haemorrhage and perforation were 1.3%, 0% and 0%, respectively. Regarding histopathological diagnosis, two (1.2%) cases showed SSLs with high-grade dysplasia. The recurrence rate in 101 lesions with a median follow-up period of 18 months (interquartile range 12-24 months) was 5.0%. There were no significant risk factors such as tumour size, location, morphology and so on in terms of recurrence. All recurrent cases could be resected by repeat CSP. The recurrence rates of lesions 10-14 mm in size and 15-20 mm in size were 4.7% and 6.3%, respectively (p = 0.713). CONCLUSION CSP of SSLs ≥10 mm in size according to magnifying endoscopic diagnosis was safe and promising, but the rate of recurrence was slightly high, meaning that close follow-up is required.
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Affiliation(s)
- Naohisa Yoshida
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Ken Inoue
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yuri Tomita
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Hikaru Hashimoto
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Satoshi Sugino
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Ryohei Hirose
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Osamu Dohi
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yuji Naito
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | - Yukiko Morinaga
- Department of Surgical PathologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
| | | | - Yutaka Inada
- Department of GastroenterologyKyoto First Red Cross HospitalKyotoJapan
| | - Takaaki Murakami
- Department of GastroenterologyAiseikai Yamashina HospitalKyotoJapan
| | - Yoshito Itoh
- Department of Molecular Gastroenterology and HepatologyGraduate School of Medical ScienceKyoto Prefectural University of MedicineKyotoJapan
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